Doctors, Midwives, Doulas: Selecting your birthing team

Choosing a prenatal healthcare provider

Deciding between a midwife or an obstetrician? Wondering if you should call in a doula for extra support? Here’s what you need to know about finding the right healthcare provider for your pregnancy, birth and beyond.

1. Family doctors or obstetricians/gynecologists Training and qualifications After four years of medical school, obstetricians and gynecologists (OB/GYNs) spend another four years studying their specialty in women’s reproductive health, usually followed by one or two years of fellowship or graduate studies. Family doctors who provide obstetrical care study for an additional two years beyond medical school.

Primary roleA woman can be referred to an OB/GYN by her family doctor or, if her pregnancy is healthy and no- or low-risk, can continue to see her family doctor right up until delivery, provided that s/he attends births. (Some don’t, in which case care would be transferred to an OB/GYN anytime within the third trimester.)

What you should knowBe prepared to make the most of your visits, as your one-on-one time with the doctor will be limited. The best way to do this is to make a list of questions ahead of time. Also, because an OB/GYN’s on-call hours are scheduled, be aware that your doctor may not be available when you deliver.

What makes their care unique This service is free to all Canadians. If you are considered as a high-risk pregnancy (such as having diabetes, high blood pressure or a history of multiple births), you must be under the care of an OB/GYN.

Primary roleThe responsibilities of a midwife are similar to those of a medical doctor (MD): They follow a prenatal visit schedule, prescribe the same lab tests and ultrasounds, and most have access to resources at local hospitals.

What you should knowA midwife’s expertise lies in the treatment of low-risk pregnancies. If a high-risk condition crops up during pregnancy, care is transferred to a doctor and the midwife stays on in a supportive role.

What makes their care unique The midwifery model promotes natural birth (as free from medical intervention as possible), informed choice, and continuity of care throughout pregnancy. With a midwife, women can choose to deliver in a hospital, birthing centre, or at home. Appointments typically last about 45 minutes, during which the physical, psychological, and emotional aspects of pregnancy are addressed.

3. Doulas Training and qualificationsThere are two organizations that offer doula certification in Canada: Childbirth and Postpartum Professional Association (CAPPA) Canada and Doulas of North America (DONA) International. Requirements for certification vary depending on the organization, but, in general, certified doulas will have completed a series of workshops and attended several births. Since the profession is still unregulated in Canada, some doulas will have had training, not all will be certified, and some will simply apprentice with other doulas. Primary role doulas are privately hired and paid to be present throughout labour and delivery to support the parents-to-be while a primary caregiver—a doctor or midwife—fulfills clinical duties. Doulas can offer physical and emotional support throughout labour, facilitate information flow, and support the patient’s partner as well.

What you should know Many doulas determine their fees based on a sliding scale, according to your income, while doulas in training will work for free. Doulas can be hired to assist throughout your entire labour, delivery, and postpartum, but some specialize in specific areas, offering care exclusively for birth or the postpartum period.

What makes their care uniqueLike midwives, doulas only take on a limited number of clients, and are typically involved two weeks prior to the due date until two weeks after you give birth. They provide telephone support during early labour and once labour is underway. Continuous support during labour provided by doulas has been associated with improved outcomes for both mothers and babies.

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